An online self-directed program combining community reinforcement approach and family training and parenting training for concerned significant others sharing a child with a person with problematic alcohol consumption: A randomized controlled trial
Open accessAbstract
Background: There is an urgent need for interventions helping children affected by parental problematic alcohol consumption (PAC). Such interventions could target partners to individuals with PAC, partners who often themselves show impaired quality of life and mental health. The aim of this study was to investigate the efficacy of an online self-directed intervention combining components from Community Reinforcement Approach and Family Training (CRAFT) with a parenting training program for concerned significant others (CSOs) sharing a child with a co-parent with PAC. Methods: A randomized controlled parallel-group superiority trial compared the efficacy of the online intervention for CSOs sharing a child (3–11 y/o) with a co-parent with PAC (N = 37), to an active control group (N = 39) receiving written psychoeducational material. Assessment of outcomes was conducted at baseline, 3 weeks, 8 weeks and 12 weeks. Primary outcome was children’s mental health, while secondary outcomes included parental self-efficacy, CSO mental health and co-parent alcohol consumption and level of dependence. Linear mixed effect models with a factorial time variable were used to model time by group interaction effects. Results: Recruitment rate was slow and a vast majority of interested CSOs were excluded at baseline assessment, mainly due experience of co-parent violence. The target sample size was not met. The intention to treat analysis did not show any significant time by group effects on either the primary or secondary outcomes during the follow-up period: the CSOs reported a significant reduction in co-parent alcohol consumption and severity of alcohol dependence and showed significant improvements in parental self-efficacy for how to handle effects of co-parent alcohol consumption, but no differences were found between the two conditions. Conclusions: The current study found no evidence supporting efficacy of a novel, online self-directed intervention on children’s mental health, CSO mental health and co-parent alcohol related outcomes. Engaging in a support program or receiving information appears to initiate behavior change in the CSOs which affects the alcohol consumption and severity of dependence for co-parents with PAC. It is suggested that future studies may preferably focus on CSOs in more severely affected contexts. Trial registration The trial was pre-registered at isrctn.com reference number ISRCTN38702517, November 28, 2017.
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Previous studies examining CRAFT in an online automated self-guided format have generally shown poorer outcomes compared to CRAFT delivered face-to-face.
“Previous studies examining CRAFT in an online automated self-guided format have generally shown poorer outcomes compared to CRAFT delivered face-to-face.”
From Online community reinforcement and family training (CRAFT) for rural concerned significant others: A randomized controlled trial (2026) · cites this paper as Siljeholm et al., 2022
The Discussion (page unavailable) says self-delivered CRAFT, mainly through workbooks, was less effective than individual or group delivery, and that online CRAFT trials had not shown significant treatment-entry results. It does not establish that previous studies of automated, self-guided online CRAFT generally found poorer outcomes than face-to-face CRAFT. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThe studies by Eék et al. (2020) and Siljeholm et al. (2022) were conducted in Sweden.
“As these studies were conducted in Sweden (Eék et al., 2020”
From Online community reinforcement and family training (CRAFT) for rural concerned significant others: A randomized controlled trial (2026) · cites this paper as Siljeholm et al., 2022
Previous online CRAFT trials relied solely on videos and reading materials.
“Similar to previous online CRAFT trials that relied solely on videos and reading materials (Eék et al., 2020”
From Online community reinforcement and family training (CRAFT) for rural concerned significant others: A randomized controlled trial (2026) · cites this paper as Siljeholm et al., 2022
The Discussion (page not available) mentions previous online CRAFT trials, including a therapist-assisted trial, but does not describe their materials in enough detail to establish that they relied solely on videos and reading. The Interventions section describes written material and short films in this paper’s own program, which does not verify the claim about previous trials. (LLM, conf=0.72)
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Cites
Self-efficacy mechanism in human agency
Bandura, A. (1982) · American Psychologist · doi:10.1037/0003-066x.37.2.122 · Cited by 15,975 · see citing works
The Strengths and Difficulties Questionnaire: A research note
Goodman, R. (1997) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.1997.tb01545.x · Cited by 14,908 · see citing works
Lovibond, P. F., & Lovibond, S. H. (1995) · Behaviour Research and Therapy · doi:10.1016/0005-7967(94)00075-u · Cited by 14,523 · see citing works
Bush, K. (1998) · Archives of Internal Medicine · doi:10.1001/archinte.158.16.1789 · Cited by 6,196 · see citing works
Dawson, D. A., Grant, B. F., Stinson, F. S., & Zhou, Y. (2005) · Alcoholism Clinical and Experimental Research · doi:10.1097/01.alc.0000164374.32229.a2 · Cited by 704 · see citing works
Psychometric properties of a Swedish version of the "Strengths and Difficulties Questionnaire"
Smedje, H., Broman, J., Hetta, J. E., & von Knorring, A. ‐. (1999) · European Child & Adolescent Psychiatry · doi:10.1007/s007870050086 · Cited by 416 · see citing works
Universal school-based prevention programs for alcohol misuse in young people
FOXCROFT, D. R., & Tsertsvadze, A. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009113 · Cited by 395 · see citing works
Analyzing longitudinal data with missing values
Enders, C. K. (2011) · Rehabilitation Psychology · doi:10.1037/a0025579 · Cited by 321 · see citing works
The reliability of Form 90: an instrument for assessing alcohol treatment outcome.
Tonigan, J. S., Miller, W. R., & Brown, J. M. (1997) · Journal of Studies on Alcohol · doi:10.15288/jsa.1997.58.358 · Cited by 312 · see citing works
Miller, W. R., Meyers, R. J., & Tonigan, J. S. (1999) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.67.5.688 · Cited by 304 · see citing works
Miller, W. R., Meyers, R. J., & Tonigan, J. S. (1999) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.67.5.688 · Cited by 302 · see citing works
Community reinforcement and family training (CRAFT): engaging unmotivated drug users in treatment
Meyers, R. J., Miller, W. R., Hill, D. E., & Tonigan, J. S. (1998) · Journal of Substance Abuse · doi:10.1016/s0899-3289(99)00003-6 · Cited by 254 · see citing works
Parenting self-efficacy, parenting stress and child behaviour before and after a parenting programme
Bloomfield, L., & Kendall, S. (2012) · Primary Health Care Research & Development · doi:10.1017/s1463423612000060 · Cited by 229 · see citing works
Estimates of US children exposed to alcohol abuse and dependence in the family
Grant, B. F. (2000) · American Journal of Public Health · doi:10.2105/ajph.90.1.112 · Cited by 216 · see citing works
Hesser, H. (2015) · Internet Interventions · doi:10.1016/j.invent.2015.02.003 · Cited by 192 · see citing works
Roozen, H. G., De Waart, R., & Van Der Kroft, P. (2010) · Addiction · doi:10.1111/j.1360-0443.2010.03016.x · Cited by 178 · see citing works
Internet-based parent management training: A randomized controlled study
Enebrink, P., Högström, J., Forster, M. O., & Ghaderi, A. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.01.006 · Cited by 174 · see citing works
Casswell, S., You, R. Q., & Huckle, T. (2011) · Addiction · doi:10.1111/j.1360-0443.2011.03361.x · Cited by 167 · see citing works
Understanding and modifying the impact of parents' substance misuse on children
Velleman, R. D. B., & Templeton, L. J. (2007) · Advances in Psychiatric Treatment · doi:10.1192/apt.bp.106.002386 · Cited by 166 · see citing works
Park, S., & Schepp, K. G. (2015) · Journal of Child and Family Studies · doi:10.1007/s10826-014-9930-7 · Cited by 162 · see citing works
Manning, V., Best, D. W., Faulkner, N., & Titherington, E. (2009) · BMC Public Health · doi:10.1186/1471-2458-9-377 · Cited by 151 · see citing works
Ray, G. T., Mertens, J. R., & Weisner, C. M. (2009) · Addiction · doi:10.1111/j.1360-0443.2008.02447.x · Cited by 126 · see citing works
Universal family-based prevention programs for alcohol misuse in young people
FOXCROFT, D. R., & Tsertsvadze, A. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009308 · Cited by 121 · see citing works
(2004) · Cited by 103 · see citing works
MOTIVATING SUBSTANCE ABUSERS TO ENTER TREATMENT: WORKING WITH FAMILY MEMBERS
HODGSON, R. (2005) · Addiction · doi:10.1111/j.1360-0443.2005.01277.x · Cited by 100 · see citing works
Factor structure and validity of the Depression, Anxiety and Stress Scale‐21 in Swedish translation
Alfonsson, S., Wallin, E., & Maathz, P. (2017) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12363 · Cited by 98 · see citing works
Bröning, S., Kumpfer, K., Kruse, K., Sack, P.-M., Schaunig-Busch, I., Ruths, S., Moesgen, D., Pflug, E., Klein, M., & Thomasius, R. (2012) · Substance Abuse Treatment, Prevention, and Policy · doi:10.1186/1747-597x-7-23 · Cited by 97 · see citing works
Community reinforcement and family training and rates of treatment entry: a systematic review.
Archer, M., Harwood, H., Stevelink, S., Rafferty, L., & Greenberg, N. (2020) · Addiction · doi:10.1111/add.14901 · Cited by 95 · see citing works
The 5-Step Method: Principles and practice
Copello, A. G., Templeton, L. J., Orford, J., & Velleman, R. D. B. (2010) · Drugs Education Prevention and Policy · doi:10.3109/09687637.2010.515186 · Cited by 90 · see citing works
Dadds, M. R., Sicouri, G., Piotrowska, P. J., Collins, D., Hawes, D. J., Moul, C., Lenroot, R., Frick, P. J., Anderson, V. A., Kimonis, E. R., et al. (2018) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2018.1485109 · Cited by 86 · see citing works
Berg, L., Bäck, K., Vinnerljung, B., & Hjern, A. (2016) · Addiction · doi:10.1111/add.13454 · Cited by 86 · see citing works
Nielsen, D. G., Andersen, K., Nielsen, A. S., Juhl, C. B., & Mellentin, A. I. (2021) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2021.02.006 · Cited by 84 · see citing works
The effect of the severity of parental alcohol abuse on mental and behavioural disorders in children
Raitasalo, K., Holmila, M. J., Jääskeläinen, M., & Santalahti, P. (2018) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-018-1253-6 · Cited by 82 · see citing works
Bischof, G., Iwen, J., Freyer-Adam, J., & Rumpf, H.-J. (2016) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2016.04.015 · Cited by 81 · see citing works
Trentacosta, C. J., Criss, M. M., Shaw, D. S., Lacourse, É., Hyde, L. W., & Dishion, T. J. (2011) · Child Development · doi:10.1111/j.1467-8624.2011.01626.x · Cited by 79 · see citing works
Children of alcoholics: an update
Lieberman, D. Z. (2000) · Current Opinion in Pediatrics · doi:10.1097/00008480-200008000-00009 · Cited by 79 · see citing works
Mathai, J., Anderson, P. J., & Bourne, A. (2003) · Australasian Psychiatry · doi:10.1046/j.1440-1665.2003.00544.x · Cited by 71 · see citing works
Björnsdotter, A., Enebrink, P., & Ghaderi, A. (2013) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/1753-2000-7-40 · Cited by 71 · see citing works
Ulfsdotter, M., Enebrink, P., & Lindberg, L. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-1083 · Cited by 61 · see citing works
Self-Report of Drinking Compared to Objective Markers of Alcohol Consumption
Whitford, J. L., Widner, S. C., Mellick, D., & Elkins, R. L. (2009) · The American Journal of Drug and Alcohol Abuse · doi:10.1080/00952990802295212 · Cited by 57 · see citing works
Community Reinforcement and Family Training: A pilot comparison of group and self-directed delivery
Manuel, J. K., Austin, J. L., Miller, W. R., McCrady, B. S., Tonigan, J. S., Meyers, R. J., Smith, J. E., & Bogenschutz, M. P. (2012) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2011.10.020 · Cited by 55 · see citing works
Dahlberg, A., Fält, E., Ghaderi, A., Sarkadi, A., & Salari, R. (2019) · Scandinavian Journal of Psychology · doi:10.1111/sjop.12606 · Cited by 52 · see citing works
Orford, J. (2017) · Drugs Education Prevention and Policy · doi:10.1080/09687637.2016.1189876 · Cited by 51 · see citing works
Prevention programmes for children of problem drinkers: A review
Cuijpers, P. (2005) · Drugs Education Prevention and Policy · doi:10.1080/09687630500337162 · Cited by 49 · see citing works
Web-Based Self-Help for Problematic Alcohol Use: a Large Naturalistic Study
Johansson, M., Sinadinovic, K., Hammarberg, A., Sundström, C., Hermansson, U., Andréasson, S., & Berman, A. H. (2016) · International Journal of Behavioral Medicine · doi:10.1007/s12529-016-9618-z · Cited by 42 · see citing works
Self-citationMellentin, A. I., Brink, M., Andersen, L., Erlangsen, A., Stenager, E. N., Bjerregaard, L. B. S., & Christiansen, E. (2016) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2016.06.001 · Cited by 40 · see citing works
Eék, N., Romberg, K., Siljeholm, O., Johansson, M., Andréasson, S., Lundgren, T., Fahlke, C., Ingesson, S., Bäckman, L., & Hammarberg, A. (2019) · Alcohol and Alcoholism · doi:10.1093/alcalc/agz095 · Cited by 39 · see citing works
Self-citationRaninen, J., Elgán, T. H., Sundin, E., & Ramstedt, M. (2015) · Scandinavian Journal of Public Health · doi:10.1177/1403494815601525 · Cited by 34 · see citing works
Nayoski, N., & Hodgins, D. C. (2016) · Journal of Gambling Issues · doi:10.4309/jgi.2016.33.11 · Cited by 34 · see citing works
Mason, W. A., Chmelka, M. B., & Thompson, R. W. (2012) · Child & Youth Care Forum · doi:10.1007/s10566-012-9179-5 · Cited by 29 · see citing works
Martikainen, P., Korhonen, K., Moustgaard, H., Aaltonen, M., & Remes, H. (2018) · Social Science & Medicine · doi:10.1016/j.socscimed.2018.09.060 · Cited by 24 · see citing works
A Pilot Trial of Online Training for Family Well-Being and Veteran Treatment Initiation for PTSD
Erbes, C. R., Kuhn, E. R., Polusny, M. A., Ruzek, J. I., Spoont, M. R., Meis, L. A., Gifford, E. V., Weingardt, K. R., Campbell, E. H., Oleson, H., et al. (2019) · Military Medicine · doi:10.1093/milmed/usz326 · Cited by 23 · see citing works
A Cost-Effectiveness Analysis of the Swedish Universal Parenting Program All Children in Focus
Ulfsdotter, M., Lindberg, L., & Månsdotter, A. (2015) · PLoS ONE · doi:10.1371/journal.pone.0145201 · Cited by 21 · see citing works
Changes in alcohol consumption between 2009 and 2014 assessed with the AUDIT
Källmén, H., Wennberg, P., Ramstedt, M., & Hallgren, M. Å. (2015) · Scandinavian Journal of Public Health · doi:10.1177/1403494815576268 · Cited by 17 · see citing works
Children’s experiences of the role of the other parent when one parent has addiction problems
Alexanderson, K., & Näsman, E. (2016) · Drugs Education Prevention and Policy · doi:10.1080/09687637.2016.1218824 · Cited by 17 · see citing works
Haugland, S. H., & Elgán, T. H. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18105412 · Cited by 14 · see citing works
Hellum, R., Bilberg, R., Andersen, K., Bischof, G., Hesse, M., & Nielsen, A. S. (2022) · BMC Public Health · doi:10.1186/s12889-022-13293-8 · Cited by 13 · see citing works
Lindner, P., Siljeholm, O., Johansson, M., Forster, M. O., Andréasson, S., & Hammarberg, A. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-020879 · Cited by 8 · see citing works
Self-citationWurdak, M., Kuntsche, E. N., & Wolstein, J. R. (2016) · Drugs Education Prevention and Policy · doi:10.1080/09687637.2016.1201459 · Cited by 4 · see citing works
Mothering in the context of fathers’ problematic alcohol use
Ekström, V., & Johansson, M. (2020) · European Journal of Social Work · doi:10.1080/13691457.2020.1793105 · Cited by 3 · see citing works
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Osilla, K. C., Manuel, J. K., Becker, K., Nameth, K., Burgette, L., Ober, A. J., DeYoreo, M., Lodge, B. S., Hurley, B., & Watkins, K. E. (2024) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2024.209290 · Cited by 8 · see citing works
Wall, H., Hansson, H., Zetterlind, U., Kvillemo, P., & Elgán, T. H. (2024) · Journal of Medical Internet Research · doi:10.2196/52118 · Cited by 7 · see citing works
Siljeholm, O., & Ekström, V. (2023) · Addiction Science & Clinical Practice · doi:10.1186/s13722-023-00369-y · Cited by 6 · see citing works
Self-citationCamargo, C. C. D. O., Neto, F. L., & Tavares, H. (2023) · Journal of Marital and Family Therapy · doi:10.1111/jmft.12637 · Cited by 4 · see citing works
Gray, H., Ivory, N., Snowdon, N., Ahmed, K. Y., Thomas, M., & Allan, J. (2026) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2025.209867 · Cited by 2 · see citing works
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Hellum, R., Hammarberg, A., & Nielsen, A. S. (2025) · Sustainable development goals series · doi:10.1007/978-3-031-82583-5_19 · Cited by 1 · see citing works
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Gray, H., Ivory, N. J., Snowdon, N., Ahmed, K. Y., Thomas, M., & Allan, J. (2025) · Qeios · doi:10.32388/qh8nxo
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- Authors
- Siljeholm, O., Lindner, P., Johansson, M., & Hammarberg, A.
- Affiliations
- Region Stockholm (SE)
- Corresponding author
- Siljeholm, Ola
- Venue
- Addiction Science & Clinical Practice
- Published
- 2022-09-05
- Volume
- 17
- Issue
- 1
- Pages
- 49-49
- ISSN
- 1940-0632 (ISSN-L)
- 1940-0640
- PMC
- PMC9446578
- OpenAlex
- W4294653776
- Cited by
- 12
- References
- 59
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 2 · 2023: 3
- FWCI
- 1.62
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Addiction Science & Clinical Practice (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Folkhälsomyndigheten
- Systembolaget Aktiebolag
- Stockholms Läns Landsting
- The Krica Foundation
- Karolinska Institute
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Counseling, Therapy, and Family Dynamics
- Social Sciences › Health › Intimate Partner and Family Violence
- Keywords
- parent training, concerned significant others, co-parents, child mental health, parental self-efficacy, alcoholism, family intervention
- MeSH terms
- Alcohol Drinking, Alcoholism, Child, Humans, Parents, Quality of Life, Parenting
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